Predictive Factors of Extubation Failure in COVID-19 Mechanically Ventilated Patients

被引:2
|
作者
Guzatti, Natalia Godoy [1 ]
Klein, Fernanda [1 ]
Oliveira, Julia Almeida [1 ]
Ratico, Gustavo Bruno [2 ]
Cordeiro, Marcos Freitas [1 ,3 ]
Marmitt, Luana Patricia [1 ,3 ]
de Carvalho, Diego [1 ,3 ]
Nunes Filho, Joao Rogerio [1 ,2 ]
Baptistella, Antuani Rafael [1 ,2 ,3 ]
机构
[1] Univ Oeste Santa Catarina UNOESC, Joacaba, SC, Brazil
[2] Hosp Univ Santa Terezinha, Joacaba, SC, Brazil
[3] Univ Oeste Santa Catarina, Programa Posgrad Biociencias & Saude, Joacaba, SC, Brazil
关键词
COVID-19; mechanical ventilation; weaning; extubation; predictive factors; RESPIRATORY-DISTRESS-SYNDROME; OCCLUSION PRESSURE;
D O I
10.1177/08850666221093946
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: We investigated whether COVID-19 patients on mechanical ventilation (MV) had a different extubation outcome compared to non-COVID-19 patients while identifying predictive factors of extubation failure in the former. Methods: A retrospective, single-center, and observational study was done on 216 COVID-19 patients admitted to an intensive care unit (ICU) between March 2020 and March 2021, aged >= 18 years, in use of invasive MV for more than 24 h, which progressed to weaning. The primary outcome that was evaluated was extubation failure during ICU stay. A statistical analysis was performed to evaluate the association of patient characteristics with extubation outcome, and a Poisson regression model determined the predictive value. Results: Seventy-seven patients were extubated; the mean age was 57.2 years, 52.5% were male, and their mean APACHE II score at admission was 17.8. On average, MV duration until extubation was 8.7 +/- 3.7 days, with 14.9 +/- 10.1 days of ICU stay and 24.6 +/- 14.0 days with COVID-19 symptoms. The rate of extubation failure (ie, the patient had to be reintubated during their ICU stay) was 22.1% (n = 17), while extubation was successful in 77.9% (n = 60) of cases. Failure was observed in only 7.8% of cases when evaluated 48 hours after extubation. The mean reintubation time was 4.28 days. After adjusting the analysis for age, sex, during of symptoms, days under MV, dialysis, and PaO2/FiO2 ratio, some parameters independently predicted extubation failure: age >= 66 years (APR = 5.12 [1.35-19.46]; p = 0.016), >= 31 days of symptoms (APR = 5.45 [0.48-62.19]; p = 0.016), and need for dialysis (APR = 5.10 [2.00-13.00]; p = 0.001), while a PaO2/FiO2 ratio >300 decreased the probability of extubation failure (APR = 0.14 [0.04-0.55]; p = 0.005). The presence of three predictors (ie, age >= 66 years, time of symptoms >= 31 days, need of dialysis, and PaO2/FiO2 ratio < 200) increased the risk of extubation failure by a factor of 23.0 (95% CI, 3.34-158.5). Conclusion: COVID-19 patients had an extubation failure risk that was almost three times higher than non-COVID-19 patients, with the extubation of the former being delayed compared to the latter. Furthermore, an age >= 66 years, time of symptoms >= 31 days, need of dialysis, and PaO2/FiO2 ratio > 200 were independent predictors for extubation failure, and the presence of three of these characteristics increased the risk of failure by a factor of 23.0.
引用
收藏
页码:1250 / 1255
页数:6
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